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I <br /> 477PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 [ FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> .,.,, P ROJECTSITZINIFORMATION , <br /> PROJECT SITEDR SS: PROPERTY TAX#: <br /> G <br /> x99.1� 42AIU1M PO1M <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> StattdaatittdtglaatiEO:k2:EM!g.CNicgk5,2a6d4ONITA:PTillNIFQRMiktg!NMEMRI'l:,;glgittiNr',Iln:NgE;M:tlaffi::.M..k:::; :Mtgt <br /> OWNER NAME: C. A C... fER .,uSO// TENANT NAME(If Commercial): Aci,Ayj EszenieEs INC <br /> OWNER MAILING ADDRESS: STREET Pi 2.1 eviR/1.,{D A ye- <br /> c- G v&rQ L r''r STATE A ZIP <br /> OWNER PHONE: ej Zs-- 870-2 93/ OWNER EMAIL: <br /> CONTRACTOR NAME: ..=4/iro ,gOcfte.6- ge-ILt/z c S Z.Z. <br /> CONTRACTOR ADDRESS: STREET / P7J Sre i €-r p-i) <br /> CITY So/NA/et-4 STATE //jA <br /> ZIP g39. <br /> CONTRACTOR PHONE: 95-5/6-��Lae& CONTRACTOR EMAIL: gie7;AChir,Ff,f JC / 5?f,CO'7 I <br /> CONTRACTOR LICENSE#(REQUIRED)�,/VF/e/f5G g71 c€9._ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) W t gaa <br /> PRIMARY CONTACT: 0 OWNER ,ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: G`w 57( - ..3 ecf <br /> Coizty 1 Au-7;x ANL CONTACT EMAIL: <br /> n BUILDING:PERMIT,APPLICATION,. <br /> Existing Use of Building: Contract Price of Work:$ 1 600.CC) <br /> Proposed Use of Building: Heat Source: ,Tas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-of Units: ykommercial ❑Industria l <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign El Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> REC.bt-Ar act p F rile 67 A-S //1Fr"rc--1,-- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION „ , N „ ;, : PLUMBINOP ORM I.T APPLICATION : I <br /> Type of Project: New_ Addn Alteration Repair Type of Project: New _Addn Alteration , Repair I <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain Q <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap 1 <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas 1 <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> 1 <br /> a_'_ SPRINKLER; SUPPRESSION SYSTEM;. <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comp! with the State Contrac Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / i� PERMIT# AA ( ,707 ,012, <br /> OwneriAu orized gent Si ature Date (Revised 10/12/2095) <br /> 1 <br /> i <br />